The Usefulness of Double-balloon Enteroscopy in Gastrointestinal Stromal Tumors of the Small Bowel with Obscure Gastrointestinal Bleeding
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概要
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Objective Gastrointestinal stromal tumors (GISTs) are the most frequently occurring mesenchymal tumors of the GI tract. Double-balloon enteroscopy (DBE) and capsule endoscopy (CE) promise the detection and accurate diagnosis of small bowel diseases in patients with obscure GI bleeding (OGIB). The aim of the present study was to analyze the clinical characteristics of small bowel GISTs and the usefulness of DBE, CE and computed tomography (CT). Methods Among 705 cases with OGIB examined between December 2003 and January 2011, 12 (1.7%) cases of small bowel GIST were identified. We analyzed endoscopic appearance, tumor-size and location, detection rate by DBE, CE and CT and clinical course in each of these cases. Results Of the 12 patients with GIST, eight were men. The mean patient age was 53.6 years. The presenting symptoms in most patients included tarry stools and/or anemia. Six patients required blood transfusions. The detection rates of DBE, CE and CT were 92%, 60% and 67%, respectively. All cases, except for one incomplete study, were identified using DBE; however, one case was not diagnosed as a tumor because of the presence of extramural growth. A pathological diagnosis of GIST was obtained using biopsies during DBE in three (45%) of seven cases. Lower detection rates were found in cases with intramural and extramural growth, larger tumors (≥35 mm) detected by CE and intraluminal growth and smaller tumors (<35 mm) detected by CT. Conclusion DBE or a combination of CE and CT are thus considered to be useful for detecting small bowel GISTs.
著者
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Tominaga Kazunari
Department Of Gastroenterology Osaka City University Graduate School Of Medicine
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Hirakawa Kosei
Department Of Surgical Oncology Osaka City University Graduate School Of Medicine
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Tanigawa Tetsuya
Department Of Gastroenterology Osaka City University Graduate School Of Medicine
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Okazaki Hirotoshi
Department Of Gastroenterology Osaka City University Graduate School Of Medicine
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Ohsawa Masahiko
Department Of Diagnostic Pathology Osaka City University Graduate School Of Medicine
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Arakawa Tetsuo
Department Of Gastroenterology Graduate School Of Medicine Osaka City University Medical School
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Machida Hirohisa
Department Of Gastroenterology Osaka City University Graduate School Of Medicine
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Nagami Yasuaki
Department Of Gastroenterology Osaka City University Graduate School Of Medicine
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Wakasa Kenichi
Department Of Diagnostic Pathology Osaka City University
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Nakatani Masami
Department Of Orthopaedic Surgery Nakatani Hospital
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Yamagami Hirokazu
Department Of Gastroenterology Osaka City University Graduate School Of Medicine
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Kameda Natsuhiko
Department Of Gastroenterology And Hepatology Osaka City University Graduate School Of Medicine
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Sugimori Satoshi
Department Of Gastroenterology Osaka City University Graduate School Of Medicine
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Watanabe Toshio
Department Of Chemistry University Of Tsukuba
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Watanabe Kenji
Department Of Agricultural Chemistry College Of Agriculture And Veterinary Medicine Nihon University
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Fujiwara Yasuhiro
Department of Breast Oncology and Medical Oncology, National Cancer Center Hospital
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Maeda Kiyoshi
Department of Medical Rehabilitation, Kobe Gakuin University
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Kameda Natsuhiko
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
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Hirakawa Kosei
Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Japan
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Watanabe Toshio
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
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Noda Eiji
Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Japan
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Nakatani Masami
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
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Nagami Yasuaki
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
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Maeda Kiyoshi
Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Japan
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Ohsawa Masahiko
Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Japan
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